ENGLEWOOD, Colo. – People with spinal cord injury (SCI) use complementary and integrative healthcare (CIH) primarily to help manage pain, according to a new study led by Craig Hospital's research team and funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
Craig Hospital Research Scientist Jennifer Coker, PhD, MPH, served as lead investigator along with Craig team members Susan Charlifue, PhD, FISCoS, FASIA, FACRM, and Jeffrey C. Berliner, Doctor of Osteopathic Medicine, as well as participants from other centers, Amanda Botticello, PhD and Jeanne Zanca, PhD of Kessler Foundation; Thomas N. Bryce, MD of Icahn School of Medicine at Mount Sinai; David Chen, MD of Shirley Ryan AbilityLab; David Estrada, JD and Ross Zafonte, DO of Spaulding Rehabilitation Hospital; Kimberley R. Monden, PhD of University of Minnesota Medical School; and Heather Taylor, PhD of Texas Institute for Rehabilitation Research.
CIH – which includes massage, vitamin supplements, and cannabis, among other things – has gradually increased among the general population, as well as among people with disabilities. Previous surveys of people with SCI found that the majority of those surveyed had tried at least one alternative treatment to manage these challenges. This new Craig study shows people with SCI are utilizing CIH at even higher rates to alleviate or manage symptoms related to their disability. However, there is little research on how CIH is used in this population or whether CIH approaches are effective or safe for people with SCI.
"Among people with disabilities, those with spinal cord injury can experience a wide range of health conditions associated with their injury," Dr. Coker says. "These conditions include physical issues such as pain, spasticity, and bladder/bowel issues, and mental health issues such as depression and anxiety."
The study found the following:
- Less than half of the sample had used CIH before their SCI and were significantly more likely to have used CIH after their injury.
- About 80% of the sample had used CIH since their SCI, with almost 70% of the sample currently using at least one type of CIH.
- Only 20% of the participants had not used any CIH since their injury.
- Participants were currently using an average of four types of CIH. The most common types were multivitamin supplements, massage, cannabis, and Vitamin D. Participants also reported using cannabidiols (CBDs), a derivative of cannabis, to a lesser extent.
- The most common reasons for using CIH were pain management, general health and wellness, bladder management, and mobility/flexibility/strength.
- The most common CIH tried after injury, but since discontinued, were acupuncture, massage, and chiropractic care.
- The most common reasons for discontinuing use of CIH were feeling like the CIH approaches weren't helping, feeling like there was no further need for use, and cost. Other reasons cited were finding a different approach more effective, recommendation from their provider, and issues with legality (e.g., cannabis).
- For those participants who didn't use CIH at all after their injury, the reasons that were cited for lack of use were not knowing what options were available, feeling as if they don't need CIH, and that their primary care physician had not recommended CIH.
"This study sought to gain an understanding of the use of CIH in people with SCI. We wanted to know how common it is for people with SCI to use – or not use – CIH after their injury," Dr. Coker says. "We also sought to identify the most frequently used types of CIH among people with SCI, their reasons for using or discontinuing use, and reasons for not using CIH at all."
Researchers analyzed survey responses from 411 people with SCI who were enrolled in a SCIMS center between January 2017 and July 2020. The participants answered questions about types of CIH they were currently using and had tried but discontinued, and whether they used CIH for general health or for a specific issue. If they had used CIH in the past but were not using it currently, they indicated how long ago they stopped and reasons for stopping the treatment. The survey also collected demographic information (i.e., age, income, education level, marital status, job status, sex, race/ethnicity, insurance carrier) and injury-related information (i.e., age at injury, injury cause, injury severity and spinal level, and time since injury).
"Providing CIH education to clinicians and people with SCI may represent a positive step toward improving the well-being and sense of autonomy over healthcare decisions for people with SCI," Dr. Coker says.